Individual provider Active NPI

Melissa Marie Sutton, PA-C

  • Physician Assistant
  • Orange Park, FL
National Provider Identifier
1730631482
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9109875 Issued in FL
Practice address
1544 County Road 220 Ste 100
Orange Park, FL 32003-4991
Phone
(904) 830-9009
NPI assigned
Oct 28, 2016
Last updated
Dec 2, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9109875 FL Primary

Addresses

Primary practice location

1544 County Road 220 Ste 100
Orange Park, FL 32003-4991

Mailing address

1544 County Road 220 Ste 100
Orange Park, FL 32003-4991
Phone (919) 452-1232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221205001902 FL Practitioner - Physician Assistant 3476922956 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Solantic of Jacksonville LLCGroup PAC ID 1052409307, 56 clinicians

Practice addresses (Care Compare)

1021 Cesery Blvd
Jacksonville, FL 32211-5609
Phone (615) 600-4074

12303 San Jose Blvd
Jacksonville, FL 32223-2640
Phone (615) 600-4074

151 Pine Lake Dr
Suite B
Ponte Vedra, FL 32081-5182
Phone (904) 543-3677

1544 County Rd
220 Suite 100
Orange Park, FL 32003-4991
Phone (904) 830-9009

1708 Blanding Blvd
Middleburg, FL 32068-3836
Phone (615) 600-4074

2140 Kingsley Ave
Orange Park, FL 32073-5180
Phone (615) 600-4074

2401 Monument Rd
Jacksonville, FL 32225-2520
Phone (904) 642-0337

4498 Hendricks Ave
Jacksonville, FL 32207-6326
Phone (615) 600-4074

463941 Sr
200 Carespot Express Healthcare
Yulee, FL 32097-6342
Phone (615) 600-4074

9680 Argyle Forest Blvd
Suite 34
Jacksonville, FL 32222-2847
Phone (904) 569-7771

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9109875FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Solantic of Jacksonville, LLC CurrentSince Dec 5, 2021 Accepting new patients
Solantic of Jacksonville, LLC PastSince Sep 5, 2021 Accepting new patients

Locations

1544 County Road 220
Ste 100
Orange Park, FL 32003
Phone (904) 830-9009

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1730631482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1544 COUNTY ROAD 220 STE 100",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320034991",
            "telephone_number": "919-452-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1544 COUNTY ROAD 220 STE 100",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320034991",
            "telephone_number": "904-830-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "MELISSA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-28",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange Park, FL

Sources for this page

Verify at the official NPI Registry.